Intended for healthcare professionals


Optimal duration of exclusive breast feeding in low income countries

BMJ 2002; 325 doi: (Published 30 November 2002) Cite this as: BMJ 2002;325:1252

Six months as recommended by WHO applies to populations, not necessarily to individuals

  1. Robert E Black, professor of international health (,
  2. Cesar G Victora, professor of epidemiology (
  1. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
  2. Universidade Federal de Pelotas CP 464, 960001-970 Pelotas, RS, Brazil

    Breast feeding continues to be the norm in low income countries, but the period of exclusive breast feeding after birth is often short.w1 Accumulating evidence of the benefits of exclusive breast feeding led to a recommendation by the World Health Organization that it be done for the first six months of life,1 consistent with a previous recommendation by Unicef. This guidance seems to be based on accumulated evidence.

    Observational studies in low income populations, even in tropical settings, have shown that fluids in addition to breast milk are unnecessary to maintain hydration.2 Furthermore, the addition of water, tea, or other liquids has adverse effects on the output of breast milk, growth, and morbidity and mortality due to infectious diseases.3 w2 A reanalysis of studies in Brazil and Bangladesh has found that breastfed infants in the first six months of life who were given additional foods had a twofold to threefold higher mortality from diarrhoea and pneumonia …

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